4 Mohave County doctors prescribed 6 million opioid pills in 1 year

Four of Arizona's top opioid-prescribing doctors are located in sparsely populated Mohave County, an unusual pattern that has Gov. Doug Ducey asking if it might indicate widespread abuse of the pain pills.(Photo: Toby Talbot/AP)

Four of Arizona's top opioid-prescribing doctors are located in sparsely populated Mohave County, an unusual pattern that has Gov. Doug Ducey asking if it might indicate widespread abuse of the pain pills.

The four doctors, who were not identified, wrote prescriptions for nearly 6 million pills over a 12-month period. That's more than enough to medicate every resident of the northwest Arizona county four times a day, for a week.

Mohave County's 200,000 residents are concentrated in Kingman, Lake Havasu City and Bullhead City. It's also a short drive to Las Vegas.

"I'm not sure if it's because of the remote locations, where it's an out of sight, out of mind thing (for pharmacy monitoring)," said Kam Gandhi, executive director of the Arizona Board of Pharmacy. The county's proximity to Las Vegas may account for its outsize number of prescriptions, he said.

Ducey sought information about the prescriptions from the state board that oversees Arizona's controlled-substance monitoring program. The data showed the total number of opioid prescriptions by doctor, the total pill quantities by doctor, the doctors' home county, and other information.

The data did not contain doctors' names, locations, or other information that might identify who prescribed the medication.

Combined, 15 doctors prescribed about 14 million opioid pills, about 3 percent of all opioid prescriptions statewide, based on data from the first half of this year.

The top-prescribing doctor from Mohave County wrote 20,232 prescriptions that amounted to more than 1.9 million pills — about 7,350 pills a day.

Christina Corieri, Ducey's senior policy adviser, told The Arizona Republic that the doctor is from a location so sparsely populated "it's too small to even be a town" and is designated a "census-designated place."

"So you have an area that has less than 1,000 people and 2 million pills," Corieri said. She said she had no further information about that doctor.

The second top-prescribing doctor, also from Mohave County, wrote 15,989 prescriptions, amounting to nearly 1.6 million pills. Mohave County was also home to the doctors who ranked fourth and sixth. Those physicians wrote prescriptions for about 2.4 million pills combined.

Nine of the top doctors were from Maricopa County and two were in Pima County.

A doctor from Maricopa County, who claimed the No. 3 top-prescribing spot, wrote 15,825 prescriptions, or about 1.5 million pills.

Governor asks for an investigation

After reviewing the volume of pain medication prescriptions, the governor asked Attorney General Mark Brnovich to “immediately launch an investigation into the opioid prescriptions detailed” in a chart.

Ducey noted that more than a dozen doctors were prescribing at a rate of more than 1,000 opioid tablets a day.

"While there are legitimate reasons to prescribe opioids, these prescribing rates are shocking and profoundly disturbing," Ducey wrote in the letter. "I am deeply concerned that this information may reveal serious violations of Arizona's criminal laws."

It is unclear if the letter prompted any law-enforcement or regulatory actions.

Mia Garcia, a spokeswoman for Brnovich, declined to talk about the letter. But her statement suggested there might be an investigation.

"The Attorney General’s Office cannot disclose information related to ongoing criminal investigations," Garcia's emailed statement said. "We must protect the integrity of our investigations. In addition, we have to a duty to protect the law enforcement officers who investigate complex and dangerous criminal cases."

Doug Skvarla, director of the Controlled Substances Prescription Monitoring Program, which is managed by the pharmacy board, said information from his program was provided to the attorney general's office "for an open investigation."

Skvarla could not say whether the probe stemmed from the Ducey letter and said the program routinely provides information, upon the opening of investigations, to assist law enforcement and regulatory officials.

Public health emergency

Earlier this year, Ducey declared a public-health emergency seeking to bolster the state's efforts to battle the opioid epidemic, which claimed the lives of 790 Arizonans last year.

The effort includes a new requirement for all doctors, pharmacists, hospitals, correctional facilities, emergency medical responders, and others to report within 24 hours on suspected opioid deaths, overdoses and the use of the overdose-reversal drug naloxone.

Corieri, Ducey's adviser, said the pharmacy board sent the information to the state medical board, which investigates complaints against doctors. Additionally, she said the numbers were reviewed by experts from the pharmacy and medical boards, and public health officials.

"All of them said these numbers are really, really high," Corieri said.

Patricia McSorley, executive director of the Arizona Medical Board and the Arizona Regulatory Board of Physician Assistants, wrote in a statement to The Republic that the board has recently disciplined or restricted the licenses of "several physicians based upon prescribing violations" but did not say if Ducey's letter prompted the action against the doctors.

McSorley stated the process is driven by complaints from the public as well as governmental agencies and law-enforcement officials.

"When appropriate, referrals are made to law enforcement or other regulatory agencies and the Board cooperates fully in sharing its investigative materials with law enforcement," she wrote in an email.

Gandhi, executive director of the pharmacy board, said there is no prescribing standard with which to assess the figures since the "practice of medicine is very subjective."

But he said the volume of prescriptions and tablets is suspicious because it represents activity of individual doctors, not practices or hospitals, which can dilute the numbers of individual doctors.

He added that the opioid activity in Mohave County is particularly alarming given the county's population.